ABSTRACT
BACKGROUND: Isolated sudden sensorineural hearing loss (SSHL) has been rarely related to vertebrobasilar occlusive disorders (VBOD). This is an important issue for both neurologists and otolaryngologists, since the management and prognosis of this type of hearing loss widely differs from that of hearing loss from other causes. OBJECTIVES: To describe the clinical characteristics and report the incidence of SSHL related to VBOD. METHODS: Retrospective analysis of clinical charts from 333 patients admitted for SSHL in a large ear, nose, and throat emergency tertiary care center from 1999 to 2002. RESULTS: Four cases (1.2%) of VBOD as the unique cause of SSHL were diagnosed among 333 patients. The most typical features of these cases were the presence of one of the following characteristics: (1) bilateral SSHL, (2) associated occipital or posterior nuchal pain, and (3) the occurrence of delayed neurologic deficits. The underlying vascular disease affected the vertebral arteries: dissection in two cases and atherosclerosis in two other cases. The audiometric features of hearing loss were endocochlear in one case, of both types in one case, and unknown in two cases. Hearing recovered partially or completely. CONCLUSIONS: Our results confirm the low incidence of SSHL related to VBOD and show that the observation of endocochlear audiometric features cannot preclude a central cause in SSHL. The clinical presentation of our cases related to VBOD emphasize that a careful follow-up of any patient with SSHL is warranted and that the presence of nuchal pain suggestive of arterial dissection in younger subjects, a past history of atherosclerosis or embolism in older patients, or the occurrence of delayed associated neurologic symptoms should be considered with particular caution in this situation.
Subject(s)
Hearing Loss, Sensorineural/etiology , Hearing Loss, Sudden/etiology , Vertebrobasilar Insufficiency/complications , Adult , Audiometry , Female , Humans , Male , Middle Aged , Retrospective Studies , Vascular Diseases/complications , Vertebrobasilar Insufficiency/diagnosisABSTRACT
OBJECTIVES: Endoscopic resection of the frontal sinus floor is a minimally invasive and functional surgical procedure designed for the treatment of inflammatory sinus diseases, which avoids the side-effects of external osteoplastic obliteration. The aim of the study was to evaluate long term results and to determine computed tomographic criteria predictive of success. PATIENTS AND METHODS: Our study reports the results of 20 patients operated for nasofrontal stenosis associated or not with osteitis or secondary mucocele. RESULTS: A successful result was obtained in 90% with a mean follow-up of 3.5 years. Failures (2) were attributed to insufficient resection and to frontal sinus osteogenesis. CONCLUSION: Endoscopic frontal sinusotomy is a safe and effective procedure for large sinuses with large distance between nasion and cribriform plate, but not in case of osteogenesis and multiple mucoceles. In case of unfavourable anatomy, or for the aforementioned pathologies, the obliteration procedure should be preferred.
Subject(s)
Algorithms , Endoscopy/methods , Frontal Sinus/pathology , Frontal Sinus/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Constriction, Pathologic/diagnostic imaging , Constriction, Pathologic/pathology , Constriction, Pathologic/surgery , Female , Follow-Up Studies , Frontal Sinus/diagnostic imaging , Humans , Male , Middle Aged , Radiography , Time FactorsABSTRACT
We report the case history of a 72-year-old patient who had a giant parotid adenoma that developed over 12 years. Worrisome clinical signs started to develop when the tumor had reached the size of 50 cm and a weight of 2.6 kg. Histology reported a benign tumor of the parotid gland. We discuss this case in relation to the to similar cases in the literature, highlighting clinical and histological difficulties encountered in patients with giant tumors of the parotid.
